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THE CHEMIST SHOPPE LTD
DSH230038 Corewell Health Grand Rapids Hospitals Butterworth Hospital
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Covered Entity Details
Entity Name
Corewell Health Grand Rapids Hospitals Butterworth Hospital
Subdivision Name
BUTTERWORTH HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH230038
Entity Address
100 MICHIGAN STREET NE
GRAND RAPIDS, MI 49503-2560
Medicare Provider Number
230038
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THE CHEMIST SHOPPE LTD
Pharmacy Address
1900 WEALTHY ST SE STE 105
GRAND RAPIDS, MI 49506-2969
Pharmacy Comments
Contract Details
Approval Date
3/7/2012
Contract Begin Date
3/7/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/20/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark Guzicki, Vice President, Home and Community Based Services
(616) 648-9143
Contract Pharmacy Representative
David McDiarmid, President
(616) 774-7799
Signed By Date
2/27/2012
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